Birth Companionship Utilization
Thamini Uhai’s routine monitoring found that 82% of women delivering at intervention sites over the 15months of implementation had a companion. This was similar to the exit interviews conducted in December 2018 that found that 83% of women delivering at intervention sites at the time of the study had a companion during labor, at the time of birth, or during the postpartum period (Table 2 and Table 3). Use of birth companions increased over time, from 59% in October 2017 to 83% in December 2018 (Thamini Uhai; data not shown).At the health center level, 91% of women delivering had a birth companion, while uptake at the intervention hospital was lower (65%; Thamini Uhai; data not shown).Most women (69%) who had a birth companion learned about the pilot during antenatal care. Other women found out when they arrived at the facility (22–29%) or from a friend or family member (15–18%) (exit interview; data not shown).
Table 2
Utilization of birth companions during implementation
| Facilities | Time period | Number of Women | Any birth companion# N (%) | For women with birth companions |
DBC % | OBC % |
Births in health facilities^ | 9 intervention sites | October 2017–December 2018 | 16,465 | 13,551 (82.3) | 28.2 | 71.8 |
Women interviewed* | 9 intervention sites | December 2018 | 603 | 501 (83.1) | 55.1 | 44.9 |
Women interviewed* | 6 comparison sites | December 2018 | 486 | 100 (20.6) | 100.0 | NA |
Abbreviations: DBC=Desired birth companion; OBC=On-call birth companion; NA=Not applicable
^ Source: Thamini Uhai monitoring data
* Source: exit interviews
# Had a DBC or OBC during labor, at the time of birth, or during postpartum
Among women who had companions, 72%had OBC support(Thamini Uhai; Table 2).Use of OBCs was highest in the intervention hospital (86%) and the one urban health center (96%) (Thamini Uhai; data not shown).Focus group participants thought that many women used OBCs because: they did not know they could bring a female companion from home; the DBC they selected was not available at the time of delivery; they did not have someone to bring from home; their DBC did not have the required badge; or they preferred to use an OBC (AMDD).
Use of DBC support increased overtime. In the first month of implementation (October 2017), only 7% of women with companions used DBCs (Thamini Uhai; data not shown). By December 2018, 55% of women with companions used DBCs (exit interviews; Table 2). Throughout implementation, a third of women delivering with companions in health centers (33%) were supported by DBCs, while 14% of women delivering with companions in the intervention hospital used DBCs (Thamini Uhai; data not shown). DBCs in health centers and hospitals were most often female family members (most frequently a mother-in-law, own mother, or sister) or friends (Thamini Uhai; data not shown).When considering whom to select, women said they wanted someone “close” to them, with whom they felt comfortable, including feeling that they could ask for help, even with embarrassing things like using the bathroom. A “trustworthy” person was most often described as someone who would “keep secrets,” and not tell anyone else in the community how the woman behaved during labor. Many women also described choosing someone who lived nearby, who would be helpful or “sharp,” and not too old, but old enough to have had enough personal childbirth experience to be helpful(AMDD).
In December 2018, 83% of women who were interviewed in intervention sites had a companion at some time during childbirth, including77% of women who had a birth companion during labor, 68% at the time of delivery, and 57% in the postpartum period. DBCs were present at all stages of childbirth whereas OBCs were present primarily during labor and delivery. In comparison sites, only 6% of women had a companion in labor, 2% had one at the time of delivery, and 19% had one in the postpartum period; one in five women delivering in comparison sites (21%) had a companion during at least one period of time. (exit interviews; Table 3)
Table 3: Companionship during labor, at the time of birth and postpartum by site status
Reported Companionship
|
Women in intervention sites
|
Women in comparison sites
|
N=603
%
|
N=486
%
|
Had a companion during at least one period of time: labor, birth or postpartum
|
83.1
|
20.6
|
Had a companion during labor (% yes)
|
76.5
|
6.2
|
Had a companion at the time of birth (% yes)
|
67.8
|
2.3
|
Had a companion during the postpartum period (% yes)
|
56.9
|
19.1
|
Source: exit interviews, December 2018
Types of Support Provided by Birth Companions
Quantitative data from exit interviews indicated that birth companions provided emotional, practical and informational support to women during labor and delivery and in the postpartum period. During labor, women most commonly reported that companions: gave them advice/instructions (61%); comforted them with kind words, singing, prayer, etc. (57%); gave them fluids to drink (50%); and stayed by their side for the majority of time (43%). OBCs and DBCs offered slightly different types of support during labor: OBCs more commonly stayed by women’s side for the majority of time (68% on-call vs. 33% desired companions) and communicated with staff (56% on-call vs. 33% desired companions), while DBCs more commonly gave women fluids to drink (44% on-call vs. 53% desired companions) and food to eat (10% on-call vs. 24% desired companions). During delivery, women reported that companions: gave them advice/instructions (60%); comforted them with kind words, singing, prayer, etc. (55%), and stayed by their side for the majority of time (49%); OBCs more commonly provided these types of support compared to DBCs. During the postpartum period, women reported that birth companions gave them food to eat (89%), cleaned their clothes/linens (81%), and gave them fluids to drink (80%). Many DBCs also helped women care for their babies (64%) during the postpartum period. (exit interviews; Table 4)
Table 4: Women’s reports of types of support given by birth companions at intervention sites
Support type
|
During labor
%
|
At time of birth
%
|
Postpartum
%
|
DBC*
|
OBC^
|
Total
|
DBC*
|
OBC^
|
Total
|
DBC*
|
OBC^
|
Total
|
N=327
|
N=134
|
N=461
|
N=
204
|
N=
205
|
N=
409
|
N=
331
|
N=
12
|
N=
343
|
Cleaned my clothes/linens
|
15.9
|
3.7
|
12.4
|
13.7
|
2.3
|
8.3
|
82.8
|
33.3
|
81.1
|
Comforted me with kind words, singing, prayer, etc.
|
49.9
|
73.9
|
56.8
|
43.1
|
65.9
|
54.5
|
16.9
|
25.0
|
17.2
|
Communicated with family/husband
|
2.8
|
3.0
|
2.8
|
6.9
|
3.9
|
5.4
|
10.3
|
8.3
|
10.2
|
Communicated with staff
|
32.7
|
56.0
|
39.5
|
11.8
|
16.6
|
33.3
|
12.7
|
0.0
|
12.2
|
Gave me advice/instructions
|
51.7
|
83.6
|
61.0
|
51.5
|
67.3
|
59.4
|
18.4
|
33.3
|
19.0
|
Gave me fluids to drink
|
52.9
|
44.0
|
50.3
|
12.3
|
6.3
|
9.3
|
81.6
|
41.7
|
80.2
|
Gave me food to eat
|
23.6
|
9.7
|
19.5
|
6.4
|
2.3
|
4.7
|
90.0
|
50.0
|
88.6
|
Helped care for the baby
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
64.4
|
41.7
|
63.6
|
Helped me change position
|
6.7
|
17.2
|
9.8
|
5.9
|
19.0
|
12.5
|
6.0
|
0.0
|
5.8
|
Helped me walk around
|
23.9
|
30.6
|
25.8
|
5.4
|
6.8
|
6.1
|
6.7
|
8.3
|
6.7
|
Helped the staff
|
12.5
|
20.2
|
14.8
|
37.3
|
33.2
|
35.2
|
1.8
|
8.3
|
2.0
|
Other (help bathing, etc.)
|
1.5
|
1.5
|
1.5
|
0.5
|
1.5
|
1.0
|
8.5
|
8.3
|
8.5
|
Rubbed my back
|
7.0
|
14.2
|
9.1
|
28.4
|
38.1
|
14.2
|
1.2
|
8.3
|
1.5
|
Stayed by my side for majority of time
|
33.3
|
67.9
|
43.4
|
38.2
|
59.0
|
48.7
|
35.4
|
50.0
|
35.9
|
Supported breastfeeding
|
NA
|
NA
|
NA
|
NA
|
NA
|
NA
|
21.2
|
16.7
|
21.0
|
Abbreviations: *DBC=Desired birth companion; ^OBC=On-call birth companion; NA: Not applicable
Source: exit interviews, December 2018
Note: Additional elements of support reported by less than 10% of women who had a companion: helped ensure privacy; helped me reduce my pain (nonmedical); nothing; other (bathing, etc.); talked with me about family planning.
Focus group and qualitative interview data from AMDD’s implementation research indicated similar findings as women’s exit interviews: birth companions comforted women, provided encouragement, reduced their worries and gave them hope, gave them massages, held their hand, and alerted providers when women needed help. The research also found that DBCs provided some support before the woman arrived at the facility for delivery, as well as postpartum, whereas OBCs only provided support while the woman was at the facility. OBCs performed some tasks within the facility that desired companions did not do, such as promoting breastfeeding and family planning.(Table 5)
Table 5: Type of support provided by birth companions to women and providers
Support to women
|
Support to providers
|
Emotional
|
Informational
|
Practical/instrumental
|
• Comfort/support
• Encouragement (“sweet words”; will deliver safe by the will of God)
• Reduce worries and give hope
• Talk to women
• Stay with women all the time
• Help women feel “free”
• Becoming a friend*
|
• Give advice
• Remind women about hygiene
• Translation
• Educate women on breastfeeding, family planning, how to care for newborn*
|
• Massages
• Help women exercise
• Hold hand
• Help women into bed
• Support to urinate/vomit
• Hold legs/shoulders during delivery
• Support women to walk after delivery
• Accompany to antenatal care^
• Encourage good diet
• Help pack/carry things from home^
• Secure transport^
• Bring tea and food
• Clean women/help them get dressed after birth
• Wash clothes
• Carry the baby or belongings, and help women to postnatal ward after delivery
• Help contact family
• Carry things home once discharged^
• Cook for women^
|
• Alert providers when women need help/are ready to push
• Keep women calm
• Prepare delivery bed, clean bed after delivery
• Help bring water/support providers to clean women
• Reduce provider workload/give them time to do other things
• Explain/reinforce provider instructions to women
• Relay information to health providers (e.g., previous fistula)
• Act as a link between providers and relatives
• Welcome women to ward, collect antenatal care cards, show them beds*
• Help/remind nurses to take medical history and complete register*
• Do light cleaning tasks in labor ward*
• Hold trays and bring supplies to providers, sometimes fetching from other wards or store*
• Tell DBCs not to give local herbs or tell women to push too soon*
• Provide company/become a friend to providers*
|
Abbreviations: DBC=Desired birth companion; OBC=On-call birth companion
Source: AMDD implementation research
*OBC only
^DBC only
Providers’ Perspectives on Birth Companionship
Quantitative surveys showed that providers at intervention sites were significantly more likely than providers at comparison sites to report supporting the use of birth companions. All providers at intervention sites(N=83; 100%) reported allowing companions during labor (vs. 15% of providers at comparison sites) and 87% of providers at intervention sites reported allowing companions at the time of birth and postpartum (vs. 4% at the time of birth and 29% postpartum at comparison sites).Providers at intervention sites who reported not allowing companions at the time of birth (N=11) cited privacy concerns (63%), and that they considered companionship distracting to the woman (36%) (data not shown).Providers at intervention sites who reported not allowing companions in the postpartum period (N=11) reported the room was too small (73%) and they wanted to keep the room clean/reduce risk for infection (46%)(data not shown). (providers survey; Table 6)
Table 6: Providers’ reports on attitudes toward birth companionship by site status
Attitude
|
Intervention sites
|
Comparison sites
|
Between-site comparison p-value
|
N=83
%
|
N=85
%
|
Reports allowing a companion in labor (% yes)
|
100.0
|
15.3
|
*<0.001
|
Reports allowing a companion at the time of birth (% yes)
|
86.8
|
3.5
|
*<0.001
|
Reports allowing a companion in the postpartum period (% yes)
|
86.8
|
29.4
|
*<0.001
|
*An unpaired Student’s t test was used to identify differences in key variables by intervention and comparison sites; a value of p <0.05 was considered statistically significant.
Source: providers survey, December 2018
Providers at intervention sites who reported allowing companionship during labor or at the time of delivery said they did so because companions help the provider with their workload (65% and 58%, respectively),tell the provider if there is a change in the woman’s status or a problem (64% and 42%, respectively), provide emotional support (54% and 54%, respectively), and help a woman feel more comfortable (52% and 47%, respectively), among other responses. In the postpartum period, providers in intervention sites reported allowing companions because they get the woman what she needs (74%), tell the provider if the woman’s condition changes/there is a problem (68%), and help care for the baby (68%).Providers who reported allowing companionship reported companions were “very helpful” (83%–92%) and improved their ability to give good-quality care (86%–93%). (providers survey; Table 7)
Table 7: Providers’ perceptions of birth companionship at intervention sites among providers who allowed companionship
Opinion
|
During labor N=83 %
|
At time of birth N=83 %
|
Postpartum N=83 %
|
Why do you allow a woman to have a companion?
|
Helps provider with workload
|
65.1
|
58.3
|
27.8
|
Tells provider if change or problem (woman)
|
63.9
|
41.7
|
68.1
|
Gets woman what she needs
|
55.4
|
40.3
|
73.6
|
Gives woman emotional support
|
54.2
|
54.2
|
29.2
|
Helps woman feels more comfortable
|
51.8
|
47.2
|
26.4
|
Gives woman advice
|
28.9
|
34.7
|
22.2
|
Allows provider to be with other women
|
25.3
|
18.1
|
20.8
|
Facility policy allows it
|
18.1
|
27.8
|
9.7
|
Government policy allows it
|
1.2
|
0.0
|
0.0
|
Other
|
3.6
|
2.8
|
2.7
|
Helps care for the baby
|
NA
|
NA
|
68.1
|
Helps with breastfeeding
|
NA
|
NA
|
26.4
|
Tells provider if baby change/problem
|
NA
|
NA
|
55.6
|
Would you say that allowing companions has been satisfying or dissatisfying for you as a provider?
|
Very satisfying
|
92.8
|
87.5
|
88.9
|
A little satisfying
|
7.2
|
8.3
|
8.3
|
Neither satisfying nor dissatisfying
|
0.0
|
4.2
|
2.8
|
A little dissatisfying
|
0.0
|
0.0
|
0.0
|
Very dissatisfying
|
0.0
|
0.0
|
0.0
|
Would you say that allowing companions has been helpful or unhelpful for you as a provider?
|
Very helpful
|
91.6
|
83.3
|
90.3
|
A little helpful
|
8.4
|
9.7
|
6.9
|
Neither helpful nor unhelpful
|
3.6
|
6.9
|
2.8
|
A little unhelpful
|
1.2
|
0.0
|
0.0
|
Very unhelpful
|
0.0
|
0.0
|
0.0
|
Would you say that allowing companions has made it harder, has not changed your ability or has improved your ability to give good quality care?
|
Improved ability to give good quality care
|
92.8
|
86.1
|
88.9
|
Has not changed ability to give good quality care
|
7.2
|
13.9
|
11.1
|
Would you say that allowing companions has not met your expectations, met your expectations, or exceeded your expectations?
|
Exceeded expectations
|
25.3
|
20.8
|
16.7
|
Met expectations
|
71.1
|
76.4
|
80.6
|
Did not meet expectations
|
3.6
|
2.8
|
2.8
|
Source: providers survey, December 2018
Focus group discussions and key informant interviews with providers also showed consensus across all stakeholder groups that birth companions made providers’ work easier, and that providers valued this support (AMDD). The principal reason for this was that companions stayed by women’s sides and called providers when they were needed. Furthermore, all the various types of support that companions provided to women and providers are tasks that would otherwise fall on the providers; having someone else in the facility to help them therefore reduced their workloads. Providers also described ways in which they felt that birth companions made providers’ work easier: by helping women better understand providers’ instructions; helping to reassure and calm women; and helping women with movement (e.g., changing positions, going to the bathroom). Occasionally, companions interpreted between providers and women who were not able to speak Kiswahili fluently. For the most part, companions provided the types of support expected of them. But, in a few occasions, providers reported that companions did tasks that were outside companions’ scope of work, as defined by the Code of Good Practice(33),such as light cleaning around labor and delivery, but that the companions felt were necessary to make women more comfortable (e.g., if the woman vomited). (Table 5)
Health workers also appreciated when companions provided information that was relevant to the woman’s clinical management, such as whether she took traditional medicines or had had a cesarean section or fistula in a previous delivery. Some providers also valued companions for more indirect roles; for example, providers reported that having companions present meant they would be less likely to be blamed for poor outcomes or accused of mistreating women, because companions could attest to what happened and could explain how hard providers tried to help women and their babies. In addition, 1 provider and 2 OBCs described how providers appreciated the company that OBCs gave them, especially during night shifts. (AMDD)
Women’s Opinions on Birth Companionship
The majority of women interviewed at intervention sites in December 2018 were very satisfied with having a companion during labor (97%), at the time of delivery (96%), and postpartum (99%). Most women at the intervention sites also reported that the presence of a companion improved their labor, delivery and postpartum experience (82%–97%).(exit interviews; Table 8). Focus group discussions and interviews also showed that women were very happy to have had a birth companion. (AMDD)
Table 8: Women’s satisfaction with and perceptions of birth companionship among women with companions at intervention sites
Opinion
|
During labor
N=461
%
|
At time of birth
N=409
%
|
Postpartum
N=343
%
|
Level of satisfaction with having a companion
|
Very satisfied
|
97.2
|
96.3
|
99.1
|
A little satisfied
|
2.2
|
3.7
|
0.3
|
Neither satisfied nor dissatisfied
|
0.4
|
0.0
|
0.3
|
A little dissatisfied
|
0.2
|
0.0
|
0.3
|
Very dissatisfied
|
0.0
|
0.0
|
0.0
|
Influence of having a labor companion on experience
|
Made experience better
|
82.4
|
86.1
|
96.8
|
Did not change experience
|
17.4
|
13.9
|
3.2
|
Don’t know
|
0.2
|
0.0
|
0.0
|
Influence of having a companion on future use of the facility
|
Increased chance of returning
|
92.4
|
99.3
|
95.3
|
Did not change chance of returning
|
6.9
|
8.1
|
4.7
|
Don’t know
|
0.7
|
0.7
|
0.0
|
Influence of having a companion on recommending the facility to family and friends
|
Increased chance of recommending facility
|
92.2
|
92.4
|
94.5
|
Did not change chance of recommending facility
|
7.8
|
7.6
|
5.3
|
Decrease chance of recommending facility
|
0.0
|
0.0
|
0.3
|
Source: exit interviews, December 2018
“My birth companion comforted me, massaged me at the back and told me to be patient, God is with you, you will get better soon, she was telling me sweet words and then she was singing gospel songs for me so I gave birth without feeling any pain” —Focus group discussion: Women with DBCs (AMDD)
“To be honest, having a birth companion makes you feel really good, we really thank you for bringing us the birth companion because the previous births you were staying there in the labor room alone, the minute you feel like you are pushing is when you call the nurse to help you now, right now at least you just heard they have called for, if she has been called for emergency the birth companion is working to call the nurse, so you really feel comfortable when you are with a birth companion.” —Focus group discussion: Women with DBCs (AMDD)
Women’s Overall Experience of Care
When comparing intervention with comparison sites, women reported that providers at intervention sites were significantly more likely to respond to women who called for help compared to providers in comparison sites (p=0.003),to interact in a friendly way (p<0.001),to greet them respectfully (p<0.001), to try to make them more comfortable (p=0.003), and to encourage them to have a companion (p<0.001).However, women at intervention sites were significantly less likely to feel comfortable asking questions than women at comparison sites (p<0.001). Overall, women who delivered at intervention sites were less likely to report experiencing emotional abuse (defined as being spoken to in an angry or condescending way that made the woman feel badly about herself, degraded, embarrassed, or sad; p=0.023) and physical abuse (defined as being hit, slapped, pushed, pinched, kicked or receiving any other type of physical force; p=0.006) from providers. (exit interviews; Table 9)
Table 9. Women’s experience of elements of respectful maternity care by site status
Experience
|
Intervention Sites N=603
%
|
Comparison Sites
N=486
%
|
Between-site comparison
p-value*
|
Did the provider […]?
|
Attend if woman calls for help
|
98.7
|
96.1
|
0.003
|
Interact in a friendly way
|
97.7
|
91.2
|
<0.001
|
Greet respectfully
|
97.0
|
88.3
|
<0.001
|
Pay close attention throughout delivery
|
87.6
|
89.5
|
0.160
|
Try to make more comfortable
|
85.6
|
79.2
|
0.003
|
Introduce themselves
|
41.8
|
43.4
|
0.295
|
Encourage you to have a companion
|
46.6
|
11.9
|
<0.001
|
Did the woman […]?
|
Feel comfortable to ask questions
|
65.8
|
90.7
|
<0.001
|
Experience abusive behavior from provider
|
Emotional abuse
|
1.3
|
3.1
|
0.023
|
Physical abuse
|
0.0
|
1.0
|
0.006
|
* An unpaired Student’s t test was used to identify differences in key variables by intervention and comparison sites; a value of p <0.05 was considered statistically significant.
Source: exit interviews, December 2018
During the focus group discussions, women described their experiences receiving more respectful care, which they attributed to the introduction of birth companions. The most often discussed and appreciated change was the improved sense of privacy and confidentiality that came with the partitions constructed in the delivery rooms. Women deeply appreciated the privacy because they were not exposed to anyone else walking into the ward, and in particular, not seeing their private parts, during labor and delivery. (AMDD)
“… it’s different from previous time, right now you just get in and she treats you so nice, when you get there you just give birth so nice, you have your room and your bed, there no such thing as this one was looking at me or what, it’s you and your nurse, that’s good, it’s not like in the previous time, there was a bed here and another one there”—Focus group discussion: Women with OBCs (AMDD)
As was found in the exit interviews, women in focus group discussions also reported a faster response time from the health providers, since their companion was able to alert the providers immediately when a woman’s condition changed. (Table 9)This was discussed as a measure to ensure women received the timely care that they needed, as well as to provide peace of mind to the women, who knew that someone was looking out for them. Having someone to go get the nurse when a woman was ready to push was mentioned by all informant types as being one of the main reasons they appreciated the intervention. (AMDD)
Women also talked about being treated well and spoken to kindly by the nurses in the presence of their birth companions. Women said the nurses were “kind” and “good” and “received me well.” One woman in a focus group discussion suggested that her labor pain actually decreased because of the sweet words that the nurse said to her. Women spoke of this change in 2 ways: some described an overall shift in the facility culture which led to happier nurses, whereas others guessed that it had more to do with fear that the birth companion would ultimately report the nurse. (AMDD)
Lastly, when birth companions talked about their role and how it may have affected providers’ treatment of the woman they were supporting, they most often mentioned being outsiders and therefore serving as “witnesses” to providers’ behavior and being advocates for women’s rights and wishes. As one DBC said, her presence simply “helps the nurse remember her responsibilities when she sees you.” She further explained that she felt the nurses worked harder because of her simply being there (AMDD):
“…because at that time when they see you that you are close they try to work hard, because they know that this person is with a companion if I do wrong she is investigating, I may find myself given a bad or good report, so you find a nurse is careful at that moment because when she sees me she is trying her best at her ability.” —DBC
Women in intervention sites were significantly more likely to report being “very satisfied” with the care they received (p<0.001), and that the staff were “very kind” to them (p<0.001) and “very encouraging” (p<0.001).Women were asked what they were most satisfied with and women at intervention sites were statistically more likely to report that staff were kind in the way they were treated (p<0.001),used encouraging words (p<0.001), and were attentive to their needs(p<.001).(exit interviews; Table 10)
Table 10: Women’s satisfaction with care by site status
Satisfaction with care
|
Intervention sites
N=603
%
|
Comparison sites
N=486
%
|
Between-site comparison
p-value*
|
How would you rate your overall level of satisfaction with the care you received?
|
Very satisfied with care
|
93.4
|
81.3
|
<0.001
|
A little satisfied/neither satisfied nor dissatisfied/a little dissatisfied/very dissatisfied
|
6.6
|
18.7
|
|
How would you rate the staff’s kindness?
|
Very kind
|
94.0
|
80.0
|
<0.001
|
A little kind/neither kind nor unkind/a little unkind/very unkind
|
6.0
|
20.0
|
|
How would you rate the staff’s encouragement?
|
Very encouraging
|
94.4
|
81.9
|
<0.001
|
A little encouraging/neither encouraging nor discouraging/a little discouraging/very discouraging
|
5.6
|
18.1
|
|
What about your care were you satisfied with?
|
Staff was kind in the way they treated me
|
83.6
|
54.9
|
<0.001
|
Staff used encouraging words
|
59.4
|
40.3
|
<0.001
|
Staff came when I called
|
47.4
|
44.4
|
0.163
|
Staff was attentive to my needs*
|
26.4
|
16.7
|
<0.001
|
Staff stayed with me
|
27.2
|
15.2
|
0.001
|
What about your care were you dissatisfied with?
|
Nothing
|
77.9
|
52.7
|
<0.001
|
Staff did not allow me to have a birth companion
|
0.2
|
7.0
|
<0.001
|
Would you return to the facility for care in the future? (% yes)
|
99.0
|
97.3
|
0.029
|
Would you recommend this facility to friends and family? (% yes)
|
99.7
|
96.1
|
<0.001
|
* An unpaired Student’s t test was used to identify differences in key variables by intervention and comparison sites; a value of p <0.05 was considered statistically significant.
Source: exit interviews, December 2018
Almost all women across intervention and comparison sites said they would return to the facility for care in the future (99% and 97%, respectively). Women at intervention sites were significantly more likely to report that they would recommend the facility to friends and family compared to women at comparison sites(<0.001).(exit interviews; Table 10)
Outcome Indicators
Between October 2017 and December 2018, a total of 16,789 women gave birth in the 9intervention facilities and 13,424 women gave birth in the comparison facilities. Compared to the 15 months prior to the implementation of the companionship project (July 2016 to September 2017), the number of deliveries increased by 2% in intervention sites and decreased by6% in comparison sites.(Table 11)
Table 11: Birth outcomes before and during pilot implementation by site status
|
Intervention Sites (N=9)
|
Comparison Sites (N=6)
|
Indicator
|
Before Pilot*
|
During Pilot^
|
% Change
|
Significance level of % change‡
|
Before Pilot*
|
During Pilot^
|
% Change
|
Significance level of % change‡
|
Deliveries in health facilities
|
16,410
|
16,789
|
2.3%
|
NA
|
14,291
|
13,424
|
-6.1%
|
NA
|
Live births in health facilities
|
16,189
|
16,618
|
2.6%
|
NA
|
14,003
|
13,196
|
-5.8%
|
NA
|
Obstetric complications treated
|
3,199
|
3,369
|
5.3%
|
NA
|
3,873
|
3,598
|
-7.1%
|
NA
|
Direct obstetric maternal deaths
|
51
|
41
|
-19.6%
|
NA
|
74
|
64
|
-13.5%
|
NA
|
Intrapartum stillbirths
|
287
|
226
|
-21.3%
|
NA
|
294
|
231
|
-21.4%
|
NA
|
Pre-discharge neonatal deaths
|
239
|
243
|
1.7%
|
NA
|
367
|
323
|
-12.0%
|
NA
|
Direct obstetric case fatality rate (including deaths due to first trimester complications)
|
1.6
|
1.2
|
-23.7%
|
0.198
|
1.9
|
1.8
|
-6.9%
|
0.675
|
Institutional MMR (per 100,000 live births)
|
315.0
|
246.7
|
-21.7%
|
0.244
|
528.5
|
485.0
|
-8.2%
|
0.615
|
Intrapartum stillbirth rate per 1,000 births
|
17.2
|
13.1
|
-23.6%
|
0.003
|
19.7
|
16.6
|
-15.8%
|
0.046
|
Pre-discharge neonatal death rate per 1,000 live births
|
14.8
|
14.6
|
-1.0%
|
0.916
|
26.2
|
24.5
|
-6.6%
|
0.370
|
Abbreviations: MMR=Maternal Mortality Ratio; NA=Not applicable
Source: Pregnancy Outcomes Monitoring Surveys
*July 2016–September 2017
^ October 2017–December 2018
‡Significance of the difference between the two periods was tested using two proportion z test.
Maternal and neonatal mortality declined in both intervention and comparison sites. While declines were generally larger in the intervention sites than in the comparison sites, changes from pre-intervention to intervention periods were not statistically significant in either group of health facilities. (Table 11) However, there was a significant decline in the intrapartum stillbirth rate in both intervention and comparison sites (from 17.2 to 13.2 per 1,000 and from 20.1 to 16.9 per 1,000, respectively).